National Social Marketing Centre Scoping Report Lewisham PCT
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National Social Marketing Centre Scoping Report Lewisham PCT Evelyn Ward Smoking June 2007 Fiona Spotswood Contents 1.0 Smoking in England 1.1 Trends 1.2 Gender 1.3 Age 1.4 Pregnancy 1.5 Ethnic groups 1.6 Smoking in the South East 1.7 Smoking and socio-economic status 2.0 Repercussions of smoking 2.1 Illness 2.2 Health 2.3 Asthma 2.3.1 What is asthma? 2.3.2 Smoking and asthma 2.3.3 Children and asthma 2.3.4 Major studies linking passive smoking and asthma 2.4 Stress and smoking 2.5 Mental health 2.5.1 Schizophrenia 2.5.2 Alzeihmers and dementia 2.5.3 Parkinson’s 3.0 The policy backdrop 3.1 National smoking cessation programme 3.2 National cessation services 3.3 Regional tobacco policy 3.4 Health Action Zones 3.5 Lewisham PCT 3.6 Lewisham Tobacco Control Alliance 4.0 The workplace smoking bans 4.1 Impact on smoking rates and cessation 4.2 Current law and new legislation 4.4 Public support for new legislation 4.4 Uptake of smoking 4.5 Evidence from Scotland 4.6 Evidence the Republic of Ireland 5.0 Introduction to social marketing and evidence for its potential 5.1 Strategic potential of social marketing 5.1.1 Upstream social marketing 5.1.2 Prevention or reaction? 6.0 Clients 6.1 Lewisham 6.1.1 Population 6.1.2 Socio-economic indicators 6.1.3 Health 6.2 Neighbourhood 1 6.2.1 Population 6.2.2 Socio-economic indicators 6.2.3 Health in N1 6.2.4 Smoking in N1 6.3 Introduction to Evelyn 6.3.1 Population 6.3.2 Socio-economic indicators 6.3.3 The physical environment 6.3.4 Smoking in Evelyn 6.3.6 Health in Evelyn 7.0 Smoking cessation 7.1 National rates 7.2 Smoking cessation in Lewisham 7.3 Quit success rates 7.3.1 Level 2 quit rates 7.3.2 Gender 7.3.3 Ethnic groups 7.3.4 Age 7.3.5 Ward breakdown 7.3.7 Pregnant women 7.3.7 Level 3 quit rates 7.3.8 Gender 7.3.9 Age 7.3.10 Ethnicity 7.3.11 Ward differences 7.4 Feedback 7.5 Smoking cessation services in Evelyn 7.5.1 Performance of providers 7.5.2 Training available 7.5.3 Further analysis 7.5.4 Ethnicity 7.5.5 Gender 7.5.7 Age 7.5.7 Cessation aid preferences 7.5.8 Weeks of treatment required 7.5.9 Pregnant smokers 8.0 The behavioural problem 8.1 The presenting issue 8.2 Possible target groups 8.3 Questions 9.0 Behavioural influences 9.1 Pointers from behavioural theory 9.1.1 Social norms and salient beliefs 9.1.2 Subculture 9.1.3 Social capital 9.2 Assets required to overcome cultural barriers 9.2.1 Perceived self-efficacy 9.2.2 Perceived control 9.2.3 Long-term time orientation 9.3 Socio-economic pointers 9.3.1 Deprivation 9.3.2 Education and employment 9.4 Demographic pointers 9.4.1 Ethnicity 9.4.2 Gender 9.5 Additional Clues 9.5.1 Employment 9.5.2 Leisure opportunities 9.5.3 Politics 9.6 Competition to behavioural goal 9.7 Exchange 10.0 Intervention review 10.1 Review of intervention aids 10.1.1 Nicotine replacement 10.1.2 Bupropion 10.1.3 Combined behavioural and pharmacological treatments for smoking cessation 10.1.4 Non-NHS treatments 10.2 Intervention reviews 10.2.1 General reviews 10.2.2 NICE reports into behaviour change 10.2.3 Interventions for BME groups 10.2.4 Interventions for deprived communities 10.2.5 International case studies 10.2.6 Case studies 10.2.7 Prevention intervention review 10.2.8 Conclusion: What works best? 11.0 Review of potential stakeholders 11.1 Health and smoking cessation groups 11.2 Community organisations 11.3 Discussions 11.3.1 Clifton Rise 11.3.2 Mornington 11.3.3 African Community Partnership: Building healthier communities 11.3.4 Jennifer Taylor: Town Centre Manager 11.3.5 Clyde Street Early Years Centre 11.3.6 Kingfisher 11.3.7 Community Opportunities Service 11.3.8 190 Advice Centre 11.3.9 The Waldrum 11.3.10 Nightingale Pharmacy 11.3.11 Lockyer’s Pharmacy 11.3.12 The Grove Medical Centre 11.3.13 Tenants and Residents Association 11.3.14 Deptford Community Forum 11.3.15 The Evelyn Neighbourhood Management Panel 11.3.16 Lewisham Community Development Partnership 11.3.17 Deptford Green School 11.3.18 QUIT 11.3.19 Somali Group 11.3.20 The Vietnamese Community 11.3.21 Positive Place 11.3.22 Wavelengths 11.3.23 Pregnancy and smoking 11.3.24 Community drug education project 11.3.25 Riverside Youth Club 11.3.26 John Evelyn Public House 11.3.27 Dr Hashmi 11.3.28 2000 Community Action Centre 11.3.29 Police initiatives 11.3.30 Pepys Community Forum 11.3.31 REETA 11.3.32 Lewisham Refugee Network 11.3.33 Walk in Centre 11.3.34 North Downham Training Project 11.3.35 Voluntary Action Lewisham 11.3.36 Other potentially useful stakeholders 11.4 Summary 12.0 Initial segmentation 12.1 Conclusion 13.0 Recommendations for further research 13.1 Parents of asthmatic children 13.1.1 Key research questions 13.1.3 Recommended research strategy 13.2 Parents 13.2.1 Key research questions 13.2.2 Recommended research strategy 13.3 Vietnamese men 13.3.1 Key research questions 13.3.2 Recommended research strategy 13.4 Muslims 13.4.1 Key research questions 13.4.2 Recommended research strategy 13.5 Pregnant women 13.5.1 Key research questions 13.5.2 Recommended research strategy 13.6 Young people 13.6.1 Key research questions 13.6.2 Recommended research methodology 13.7 Budget guide 13.8 Timescale guide 13.9 Ethics 13.10.1 Ethics in research 13.10.2 Ethics in social marketing 14.0 Next steps Executive Summary 1. Smoking in the UK Around 10 million adults smoke cigarettes in Great Britain: this is about a quarter of the population. About half of all regular cigarette smokers will eventually be killed by their addiction. Every year, around 114,000 smokers in the UK die from smoking related causes (ASH). In 2005, 26% of men smoked and 23% women in the UK. The GHS has consistently shown that cigarette smoking is more prevalent among people in manual occupational groups than those in non-manual groups. In England in 2005, 29% of those in manual occupational groups were cigarette smokers. 2. Repercussions of smoking Smoking harms nearly every organ of the body, causing many diseases, and reduces quality of life and life expectancy. It has been estimated that, in England, 364,000 patients are admitted to NHS hospitals each year due to diseases caused by smoking. For every death caused by smoking, approximately 20 smokers are suffering from a smoking related disease. One in two long-term smokers will die prematurely as a result of smoking – half of these in middle age. The most recent estimates show that around 114,000 people in the UK are killed by smoking every year, accounting for one fifth of all UK deaths. According to ASH 1, there is sufficient evidence to suggest conclude that exposure to tobacco smoke increases asthma symptoms and attacks both for smokers and for non-smokers. The link between smoking and stress is well documented and smokers often deal with stress by lighting a cigarette. However, the relief only lasts a short time. Soon the stress will return and the smoker will need another cigarette. ASH 2 tells us that many epidemiological studies have reported an association between clinical depression and smoking. Some have concluded that the effects of long-term nicotine exposure on the brain may have a causal influence on major depression while others suggest that shared environmental or genetic factors may predispose to both smoking and major depression. 3. Targets 2005/8 4 week quitters 5867 (60 stretch) 2005/8 52 week quitters 1760 (18 stretch) 2005/6 4 week quitters 2114 (no stretch) 52 week quitters 634 2006/7 4 week quitters 1604 (30 stretch) 52 week quitters 481 2007/8 4 week quitters 2149 (30 stretch) 1 ASH Online [http://www.ash.org.uk/html/passive/html/asthma.html]. 2 http://www.ash.org.uk/html/factsheets/html/fact15.html 52 week quitter 645 The PCT has exceeded its stop smoking target of 1574 for 2006/7. This is the first time they have ever got beyond a red rating. This means the PCT will get a green rating from NHS London for this level of performance. 4. The smoking ban It is known that ending smoking in workplaces is a simple and cost-effective way to encourage smokers to quit. Wanless reported to the UK Government that “A number of other countries have now implemented a workplace smoking ban via legislation. Some of this experience has been shown to be successful in reducing the prevalence of smoking”. 54% of the UK population reportedly strongly support the smoke free law. Evidence from Scotland and the Republic of Ireland suggests the English smoking ban will have significant positive effect over smoking rates. 5. Introduction to social marketing and evidence for its potential Hastings (January 2007, unpublished) 3 explains that developments in public health show that engaging with social marketing to change voluntary behaviour “is not only desirable, but a matter of life and death.